A Cost-benefit Analysis of Participating in a National Nursing Database

Standardized nursing-sensitive indicators (NSIs) are essential for evaluating nursing quality and safety. Within the Military Health System NSI measurement is challenged by electronic health record (EHR) limitations, inconsistent documentation patterns, and inefficiencies in administrative staffing data. Participation in a national nursing database (NND), such as the National Database of Nursing Quality Indicators (NDNQI), offers standardized definitions, benchmarking, and reporting tools to guide nursing quality improvement. This paper reports a cost-benefit analysis to guide recommendations for future participation in an NND across the Defense Health Agency (DHA).

A 12-month study was implemented at 2 military treatment facilities, evaluating 28 NSIs across 14 inpatient units. Data collection included automated EHR extraction, manual methods, or hybrid collection processes. Nursing leaders completed surveys at mid and end-of-study to assess data system compatibility and NDNQI report usefulness. Quantitative and qualitative costs to the enterprise were compared to benefits.

Participation required over 450 hours logged in data collection and management. Barriers included limited automated extraction and consistent documentation. Actual benefits include demonstrating centralized extraction, and feasibility of submission. Potential benefits identified in the literature showed reductions in costly hospital-acquired conditions, improved benchmarking capability, and enhanced workforce retention. Overall, research has established that the act of monitoring performance and reporting tends to lead to improved outcomes over time.

Although initial participation was resource-intensive, literature suggests that sustained participation can yield cost savings and improvements in quality once automation and documentation standardization are achieved.